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Y2 Ophthalmology > Systemic eye disease > Flashcards

Systemic eye disease Flashcards

1
Q

What is thyroid eye disease

A

Autoimmune disease caused by activation of orbital fibroblasts by autoantibodies directed against thyroid receptors

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2
Q

Thyroid eye disease is mostly associated with

A

Grave’s

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3
Q

90% of thyroid eye disease is associated with Grave’s. How about the rest of the 10%

A

Normal functioning thyroid
Hashimoto’s

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4
Q

What are the effects on the eye due to TSH receptor autoantibodies in thyroid eye disease

A

Extraocular muscle enlargement
Orbital fat expansion

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5
Q

Describe the stages of thyroid eye disease

A
  1. Soft tissue involvement
  2. Lid retraction
  3. Proptosis
  4. Optic neuropathy
  5. Restrictive myopathy
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6
Q

Risk factors for development of thyroid eye disease

A

Smoking
Radioiodine treatment - increases the inflammatory symptoms in thyroid eye disease

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7
Q

Symptoms of thyroid eye disease

A

Periorbital swelling
Exophthalmos (proptosis)
Unable to close eyelids -> dry eyes, exposure keratopathy
Ophthalmoplegia (weakness of eye muscles) -> double / blurred vision

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8
Q

Unable to close eyelids can lead to

A

Dry, sore eyes
Exposure keratitis

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9
Q

What ophthalmological feature does dermatomyositis cause

A

Heliotrope rash on eyelids

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10
Q

Dermatomyositis is a ______ phenomenon hence ______ after diagnosis

A

Dermatomyositis is a paraneoplastic phenomenon (i.e. it is associated with malignancies - breast, lungs, ovarian) hence patients need to undergo CT chest, abdomen and pelvis after diagnosis

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11
Q

What ophthalmological conditions can Marfan syndrome cause

A

Dislocated lens
Blue sclera
Myopia

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12
Q

Which type of dislocated lens does Marfan syndrome cause

A

Superotemporal dislocation

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13
Q

What are the types of diabetic retinopathy

A

Non-proliferative
Proliferative
Macular edema

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14
Q

Pathophysiology of diabetic retinopathy

A
  1. Hyperglycaemia causes increased retinal blood flow and abnormal metabolism of glucose in retinal vessel walls
  2. This causes damage to endothelial cells and pericytes
  3. endothelial dysfunction -> increased permeability -> lipids, proteins leak out -> exudates
  4. Necrosis of the vessel wall triggers release of vascular endothelial growth factor
  5. this causes formation of new, fragile vessels which can rupture and cause visual loss
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15
Q

What is non-proliferative retinopathy

A

Early stage of diabetic retinopathy where blood vessels are weakened but have not yet formed new blood vessels

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16
Q

What is proliferative retinopathy

A

Late stage of diabetic retinopathy where new fragile blood vessels have formed

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17
Q

Weakened vessels in non-proliferative retinopathy leads to the formation of

A

microaneurysms

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18
Q

What is considered as mild NPDR

A

1 or more microaneurysm

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19
Q

What is considered as moderate NPDR

A

Microaneurysms
Blot haemorrhage
Hard exudates
Cotton wool spots

20
Q

What are cotton wool spots

A

Soft exudates which represent areas of retinal infarction

21
Q

What is considered as severe NPDR

A

Blot haemorrhages and micro aneurysms in 4 quadrants
Venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

4-2-1 rule

22
Q

What is venous beading

A

tortuosity and beading (irregular constriction and dilation) of the retinal veins

23
Q

What is IRMA

A

abnormal branching / dilation of existing retinal vessels

24
Q

What are the features of proliferative diabetic retinopathy

A

Retinal neovascularisation
Fibrous tissue forming anterior to retinal disc
Vitreous haemorrhage

25
Q

Symptom of vitreous haemorrhage

A

Sudden painless loss of vision
Floaters / dark spots in vision
Red hue in vision

26
Q

Which type of diabetes is more likely to have proliferative diabetic retinopathy

A

type 1

27
Q

What is the macula

A

Area in the center of retina which is responsible for the high acuity central colour vision

28
Q

Signs of macular oedema in diabetic retinopathy

A

Hard exudates
Oedematous changes in or around the macula
Reduced visual acuity

29
Q

Macular oedema is more common which type of diabetics

A

Type 2

30
Q

General management of diabetic retinopathy

A

Optimise glycemic control, blood pressure
Regular review

31
Q

Management of non-proliferative diabetic retinopathy

A

Regular observation
Panretinal laser photocoagulation for severe / very severe NPDR

32
Q

Management for proliferative diabetic retinopathy

A

Panretinal laser photocoagulation
Intravitreal VEGF inhibitors
Vitreoretinal surgery

33
Q

Function of intravitreal VEGF inhibitors

A

Blocks angiogenesis and decrease vascular permeability

34
Q

Examples of VEGF inhibitors

A

Ranibizumab
Aflibercept

35
Q

Management of macular oedema in diabetic retinopathy

A

intravitreal VEGF inhibitors
Vitreal surgery

36
Q

What ophthalmological conditions can steroids lead to

A

Glaucoma
Cataracts

37
Q

The effect of steroids on intraocular pressure

A

Increases the intraocular pressure

38
Q

What is neurofibromatosis type 1

A

Genetic condition that causes tumours along the nervous system

39
Q

Inheritance pattern of neurofibromatosis type 1

A

Autosomal dominant

40
Q

Neurofibromatosis type 1 is due to mutation in

A

Chromosome 17

41
Q

What are the features of neurofibromatosis type 1

A

Cafe-au-lair spots >/ 6
Axillary / groin freckles
Peripheral neurofibromas
Lisch nodules in the eyes
Optic glioma
Scoliosis
Phaeochromocytoma

42
Q

What are the eye involvements in neurofibromatosis type 1

A

Lisch nodules
Optic glioma

43
Q

What is optic glioma

A

Slow growing tumour of the optic nerve causing globe proptosis and worsening of vision

44
Q

What are Lisch nodules

A

yellow / brown dome-shaped nodules

45
Q

Which ocular involvement of NF1 is more common

A

Lisch nodules

Y2 Ophthalmology (8 decks)

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